Evaluation of closed reduction and percutaneous iliosacral cannulated screw fixation for sacroiliac disruption or sacral fractures; a preliminary study

High energy pelvic ring fractures are serious injuries result from motor vehicle accidents or fall from height, unstable pelvic ring injuries usually associated with sacroiliac disruptions or sacral fractures. The ideal treatment for unstable pelvic fractures remains a matter of debate. The main purpose of the treatment is to save the patient s life and then to achieve an excellent functional outcome. Percutaneous fixation of Sacroiliac joint disruption or sacral fractures is evolved recently as a minimal invasive technique with low complication rate and morbidities. A preliminary study to evaluate prospectively the effectiveness of the percutaneous cannulated screws fixation of posterior pelvic ring injures in unstable fractures with associated injuries. Six patients have been treated in Medical City/Baghdad [during the period of Jan.2012 till July 2012] by one surgeon, four males and two females with mean age 27 years [range 20-36 years], who have unstable pelvic ring injuries associated with other skeletal, neural or visceral injuries are treated by gradual closed reduction using skeletal traction through lower femur and percutaneous sacroiliac fixations using a 7 mm Cancellous partially threaded screws following the technique described by Matta and Saucedo using C-arm fluoroscopy. A data for the duration of procedure, blood loss, intra-operative and post-operative complications and post-operative rehabilitation were collected analyzed and compared to data for open reduction and internal fixation for the same injuries from other studies. pre and post-operative radiographs and CT scans of the pelvis were studied to evaluate the procedure. A total of 13 screw where inserted percutanously to a six patients. The duration of the surgical procedure was 30 minutes to 60 minutes including the preparation time. Wound size was 5mm-10mm, Blood loss was negligible, no anesthetic complications no intra or post-operative complications, no wound complications, and a very good post-operative rehabilitation. Postoperative X-rays and CT scans show no complications and a very good reduction and fixation for the Sacroiliac joints and sacral fractures. Gradual closed reduction and Percutaneous sacroiliac fixations using cannulated screws have demonstrated a very good minimally invasive technique with no intra-operative or post-operative complications. This technique may be advantageous as it avoids using extensive approaches, bleeding, wound complications and prolonged surgeries

Anterior Pelvic Plating and Sacroiliac Joint Fixation in Unstable Pelvic Ring Injuries

PURPOSE: To analyze the effectiveness of anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation in patients with unstable pelvic ring injuries. MATERIALS AND METHODS: Thirty-two patients were included with twenty-one males and eleven females. The mean age was 41 years (range, 19-76). The mean follow-up period was 51 months (range, 36-73). According to AO-OTA classification, there were 11 cases of B2 injuries, 8 cases of B3 injuries, 9 cases of C1 injuries, 2 cases of C2 injuries and 2 cases of C3 injuries. In the posterior lesions, there were 20 cases of sacral fractures and 12 cases of sacroiliac joint disruptions or dislocations. Anterior pelvic plating and subsequent percutaneous sacroiliac joint fixation were performed. RESULTS: The clinical results were 16 cases of excellent, 10 cases of good, 4 cases of moderate and 2 cases of poor functional results. The 2 cases out of 7 moderate reductions had poor functional results with residual neurologic symptoms. The radiological results were 16 cases of anatomic, 9 cases of nearly anatomic and 7 cases of moderate reduction. All patients were healed except 3 cases of nonunion at the pubic ramus. The complications encountered were 3 cases of screw loosening, 2 cases of anterior plate breakage and 1 case of postoperative infection. CONCLUSION: In patients with unstable pelvic ring injuries, anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation may be a useful surgical option. The radiological results and residual neurologic symptoms had effects on its functional results.

Parafusos iliosacrais são realmente seguros? / Are iliosacral screws really safe?

OBJETIVO: Avaliar a segurança do uso de fixação iliosacral com parafusos em pacientes com lesão do anel pélvico. MÉTODOS: Trata-se de um trabalho restrospectivo analisando por tomografia computadorizada a topografia de 60 parafusos inseridos em 46 pacientes portadores de lesões do anel pélvico e operados no INTO-RJ, no período de 2006 e 2010. RESULTADOS: Em 21,7 por cento dos casos o parafuso encontrava-se fora do corredor de segurança descrito em literatura. Destes, 77 por cento estavam associados a uma redução insatisfatória do anel pélvico. Não houve casos de lesão neurovascular em nossa série. CONCLUSÃO: O uso de parafusos ílio-sacrais é uma técnica segura, pois mesmo em casos onde o parafuso não respeitou uma topografia ideal, não houve complicações significativas associadas a este método. A má redução do anel pélvico é um fator muito importante associado ao mau posicionamento dos parafusos.

OBJECTIVE: To evaluate the safety of iliosacral screw fixation in pelvic injuries. METHODS: A retrospective study based on computer tomography evaluation of screw topography and its relationship with the so called pelvic safe corridor. RESULTS: We evaluated the topography of 60 screws inserted in 46 patients sustaining pelvic injuries which were operated in the INTO from 2006 to 2010. In 21.7 percent of cases the screw was located outside the safe corridor. 77 percent of these misplaced screws were associated with an unsatisfactory reduction of the pelvic injury. CONCLUSIONS: In our study, a significant rate of misplaced screws in relationship with the safe corridor has been pointed out and in most of these cases an insufficient reduction of the pelvis was also identified. We conclude that iliosacral fixation is a safe adjuvant method for pelvic fixation since in our series even with a relative high incidence of misplacements, no neurovascular injuries have been recorded in association with this technique.

Low dose CT guided percutaneous sacroiliac screw fixation

To describe the procedure and compare the radiation to the patient between a conventional CT and low dose CT and show the percentage reduction of dose to the patient under the latter protocol whilst still ensuring clinical efficacy. The study was performed in a 100 bed secondary care hospital which caters principally to the local industrial community. Patients were included in the presence of an unstable pelvic ring injury requiring posterior ring fixation. However, patients who were haemodynamically unstable; patients with head, thoracic and extensive abdominal wounds, and those who might require an open reduction procedure for posterior pelvis repair were excluded from the study. The low dose CT scan image quality was satisfactory for planning the procedure. Also, with CT guidance, the placement of screws in all cases was exactly as desired with a high level of confidence there was no complications. Fixation of sacroiliac joint fractures under CT guidance is easier than with conventional fluoroscopic guidance or open surgery. The procedure can be done even in a small set-up. Low dose CT guidance makes it more acceptable for patients and surgeons

Spino-pelvic fixation for vertically unstable type C fractures of the pelvis

Evaluating the radiological and functional results of surgical treatment of unstable pelvic injuries by spinopelvic fixation. The purpose of this study was to find out whether the surgical technique can reduce fractures of the sacrum and dislocations of the sacroiliac joint and provide pelvis with stable fixation. Ten vertical shearing pelvic fractures were treated by pedicular screw placement in L5 vertebra and in the wing of the ilium. According to Tile's classification system, there were 10 type C fractures [8 type C1, one type C2 and one type C3]. The patients were evaluated by plain radiographs at a mean follow-up period of 2 years [range 1-3 years] after surgery. The patients had a mean age of 37.3 years at the time of surgery. The fracture was reduced by skeletal traction under general anesthesia and in prone position. A pedicular screw was placed in L5 vertebra on the same side of the fracture. Another screw was placed into the pelvic wing from PSIS [posterior superior iliac spine] toward AIIS [anterior inferior iliac spine]. A molded titanium rod connected these two pedicular screws. This study supports the use of screw and rod system for posterior fixation of the VS injuries of the pelvis

Clampe de Ganz no tratamento de urgência em lesões do anel pélvico / Ganz clamps to treat emergencies in pelvic ring lesions

OBJETIVO: Avaliar a eficiência do clampe de Ganz na estabilização e redução dos deslocamentos da pelve, quando utilizado no tratamento de urgência, além de aquilatar eventuais dificuldades e facilidades do método. MÉTODOS: O clampe de Ganz foi utilizado no tratamento de urgência em 31 pacientes com graves lesões do anel pélvico (Tile C) associadas a importante instabilidade hemodinâmica. RESULTADO: Entre os pacientes, 27 (87,1 por cento) apresentaram evolução favorável, com estabilização, redução dos deslocamentos e compressão da região posterior do anel, além de estabilização hemodinâmica, e quatro (12,9 por cento) evoluíram para óbito. CONCLUSÃO: O clampe de Ganz mostrou-se eficiente ferramenta no tratamento de urgência das lesões do anel pélvico, por ser de concepção simples, de rápida colocação, não impedir ou dificultar procedimentos no abdome e, principalmente, por permitir a estabilização da pelve, redução dos deslocamentos e compressão na região posterior do anel, local onde ocorrem os maiores sangramentos, reduzindo-os ou eliminando-os.

OBJECTIVE: To evaluate the effectiveness of Ganz clamp to stabilize and reduce pelvic dislocations in emergency situations, and to assess possible difficult and easy aspects of the method. METHOD: Ganz clamp was used in the emergency treatment of 31 patients with severe lesions of the pelvic ring (Tile C) associated to major hemodynamic instability. RESULTS: Among the patients, 27 (87.1 percent) presented a favorable evolution, with stabilization, reduction of dislocations, and compression of the posterior portion of the ring, and also hemodynamic stabilization, and 4 (12.9 percent) died. CONCLUSION: The Ganz clamp was found to be an effective tool in the emergency treatment of pelvic ring lesions because it has an uncomplicated conception, allowing for a fast placement, because it does not prevent nor make it difficult for abdominal procedures, and most of all because it allows for the stabilization of the pelvis, reduction of dislocations, and compression in the posterior region of the ring, where most bleeding occurs, to reduce or eliminate bleeding.

Fijación percutánea de fracturas sacroiliacas guiada por TAC. Experiencia de 2 años / Iliosacral screw fixation of posterior pelvic ring injuries guided by CT scan

Entre Febrero de 2001 y Noviembre de 2002 se realizó un estudio observacional, descriptivo, tipo serie de casos en los Departamentos de Ortopedia y Traumatología del Hospital de San José, la Clínica Palermo y la Fundación Santa Fe de Bogotá: 10 pacientes (12 fracturas) con lesiones inestables del anillo pélvico a quienes se les realizó fijación percutánea dirigida por TAC de la porción posterior del anillo pélvico. Seis mujeres (60%) y 4 (40%) hombres, con un promedio de edad de 33.4 años (16 a 54 años). Las fracturas se clasificaron de acuerdo a la clasificación AO / OTA siendo el 50 % tipo B y el 50% tipo C. La causa de la fractura fue accidente de tránsito en 8 pacientes (80%) y caída de altura en 2 pacientes (20%). A todos los pacientes se les realizo fijación de la articulación sacro ilíaca con tornillos canulados de 7.0, bajo anestesia regional o local con sedacion, y no encontramos lesión neurológica o vascular alguna en el pre ni en el post operatorio. Tiempo quirúrgico en promedio de 50 minutos, sangrado de 7cc, corta estancia hospitalaria con un buen manejo del dolor y pronta reintegración a sus actividades diarias. En los controles POP se evaluó a través de RX la consolidación de las fracturas la cual fue del 100% en todos los pacientes.

Cálculo de la sensibilidad, especificidad y valores predictivos de la prueba clínica supino a sentado versus prueba radiográfica de certeza en un grupo de pacientes con dolor lumbar: Antofagasta 1999 / Sensibility, specificity and predicted values of the clinic test long-sitting test versus assurence radiography test in patients with lumbar pain: Antofagasta 1999

Mediante un Estudio de Tamizaje, también llamado Barrido o Examen poblacional aplicado a una muestra de 16 individuos adultos, se valoró la especificidad, sensibilidad, valores predictivos, y la razón de probabilidades del test según cada sujeto examinado. Los resultados obtenidos al analizar los informes de las evaluaciones prueba clínica v/s prueba radiográfica de certeza indican que la aplicación de la prueba supino o sentado está sujeta a importantes limitaciones respecto de su real utilidad como elemento de valoración clínica. Según lo observado en este estudio, dicha prueba es poco eficiente cuando se trata de identificar como negativos a los sujetos sanos (verdaderos negativos), cuya especificidad alcanzó un 85 por ciento, el valor predictivo positivo, genera una baja probabilidad (60 por ciento) de encontrar enfermos con test positivo-es decir de aquellos que están realmente con el problema que se quiere detectar. Consecuencialmente, todo lo anterior deriva en la alta probabilidad que tiene cada individuo de la población evaluada de ser calificado positivo. (+) ó negativo (-) independientemente de su real estado de salud

Criterios de tratamiento conservador vs quirúrgico en las lesiones del anillo pélvico / Criteria for conservative and surgical treatment for injuries of the pelvic ring

Se hace una revisión del tratamiento tanto conservador como quirúrgico en las disrupciones del anillo pélvico tipo B y C de la clasificación de Tile. Ingresaron 44pacientes al servicio de cirugía de cadera y pelvis del Hospital de Traumatología "Magdalena de las Salinas". Al tipo B1 correspondieron 9 casos (20 por ciento); B2 7 casos (16 por ciento); C3 9 casos (20 por ciento); 26 de ellos se estabilizaron quirúrgicamente; en 19 casos con fijación interna a la artículación sacroiliaca; síntesis al iliaco con placa DCP ancha, 2 casos; un fijador externo únicamente, 5 casos; síntesis al acetábulo, 7 casos y síntesis mixta 4 casos. el tipo B2 y B3, se manejó conservadoramente en un 80 por ciento. El tipo B1 requirió de estabilización con fijador externo, el tipo C1 con fijación interna y/o mixta y el tipo C3 con fijación interna de la pelvis y del acetábulo. Las lesiones asociadas son de importancia y tienen una mortalidad elevada por choque hipovolémico. Se describen los criterios de manejo en este tipo de pacientes desde urgencias

Fratura de Malgaigne em grávidas: relato de 2 casos / Malgaigne fracture in pregnant women: report of 2 cases

Os autores apresentam dois casos de fraturas instáveis da pelve em pacientes grávidas tratadas no Serviço de Ortopedia e Traumatologia da Santa Casa de Porto Alegre. A revisäo dsa literatura näo revelou descriçäo similar